Metabolic-associated steatotic liver disease (MASLD): how I evolved my approach to diagnosis and staging
File(s)
Accepted version
Supporting information
Author(s)
Type
Journal Article
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide with high morbidity and mortality rates. An early diagnosis, in primary care, seems paramount, especially in the high-risk patients with type 2 diabetes or/and obesity. As we thoroughly discuss in this review, the diagnosis and staging of MASLD has extensively evolved during recent years, especially with the introduction of non-invasive tests (NITs) in our management. According to current guidelines, a multi-tier diagnostic system is implemented in primary care in high-risk groups: the first step includes a non-patented blood test, such as Fibrosis score-4 (FIB-4), followed by an imaging modality such as transient elastography (TE) or a test based on collagen formation such as enhanced liver fibrosis test (ELF). In a specialty setting, several NITs for the diagnosis of steatosis, steatohepatitis and fibrosis, as well as for the prediction of clinical outcomes, have been developed and validated - with various performances - aiming to replace liver biopsy and to guide management decisions. However, NITs have certain limitations, particularly when applied to the general population. Further research is needed to refine and validate both existing and novel biomarkers to reliably guide stage and prognostication in this cohort.
Date Issued
2026-05-01
Date Acceptance
2025-05-27
Citation
Frontline Gastroenterology, 2026, 17 (3), pp.250-261
ISSN
2041-4145
Publisher
BMJ Publishing Group
Start Page
250
End Page
261
Journal / Book Title
Frontline Gastroenterology
Volume
17
Issue
3
Copyright Statement
© Author(s) (or their employer(s)) 2026. This is the author’s accepted manuscript made available under a CC-BY licence in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy)
License URL
Publication Status
Published
Date Publish Online
2025-06-12